What are the 5 stages of Parkinson’s Disease?

Understanding The 5 Stages of Parkinson’s Disease

Parkinson’s disease affects people in various ways, and those who live with the condition may not experience all of the typical symptoms. Those who share similar or identical symptoms may not necessarily have them at the same time or experience the same intensity. It’s a disease that progresses uniquely from person to person, and the uncertainty of what might happen next can be very difficult for patients and their loved ones to deal with. 

The early signs of Parkinson’s disease (PD) are often characterised by subtle, gradually progressing symptoms that can be easily overlooked or attributed to other causes. These may include mild tremors or shaking, stiffness or difficulty with movement, and changes in posture or balance. Other common early symptoms of PD include slowness of movement, difficulty initiating movement (called bradykinesia), and changes in speech or handwriting. Some people may also experience changes in their mood or behaviour, such as depression or anxiety, or experience changes in their sleep patterns. It is important to note that these symptoms can vary widely from person to person, and may not all be present in the early stages of the disease. It is also worth noting that PD is a progressive disorder, which means that symptoms tend to worsen over time.

With that said, it’s important to learn about the typical stages of Parkinson’s disease (PD), of which there are five, as it can prove to be a considerable benefit for recognising the disease’s progression and also establishing ways to cope with the impact it causes. This is especially crucial as some patients will move through the stages over decades, whereas others find that the disease progresses more quickly.

In this article, we’re going to explore the five stages of Parkinson’s disease in more detail.

What is Parkinson’s disease?

Before we explain the five stages of Parkinson’s disease and how it progresses, it’s important to understand what Parkinson’s disease actually is. Parkinson’s disease is caused by a loss of nerve cells in a part of the brain called the substantia nigra, leading to progressive damage to several areas of the brain over many years. The loss of nerves reduces dopamine in the brain, which plays a vital role in the body’s ability to move. This reduction of dopamine is responsible for several Parkinson’s symptoms, mostly motor symptoms, but the catalyst for losing nerve cells remains unclear. Whilst it is unclear as to who is most at risk for Parkinson’s’ Disease, research suggests the cause is due to a mixture of genetic and environmental factors.

The three typical movement symptoms of Parkinson’s disease are:

  • Involuntary shaking or a ‘tremor’ of parts of the body
  • Slow movement
  • Stiff muscles and difficulties with flexibility

Additionally, people with PD can also experience other physical and non-movement symptoms, such as:

  • Depression and anxiety
  • Balance issues
  • Losing sense of smell
  • Sleeping problems
  • Memory difficulties

Many medical professionals who diagnose Parkinson’s disease use the Hoehn and Yahr scale to classify symptoms and their severity. This scale rates the condition and breaks it down into five stages based on disease progression. The scale allows doctors to evaluate how far PD has advanced in patients and what sort of treatments may be most effective for symptom management.

What are the 5 stages of Parkinson’s disease?

There are five distinct Parkinson’s disease stages, with patients moving through each stage at varying rates, with stage 1 being the mildest and stage 5 being the most severe. Symptoms worsen over time, with some patients spending years in each stage, and others progressing to an advanced stage more quickly.

1. Changes in a Person’s Habits

At stage 1, there can be mild symptoms of PD, but they’re often not severe enough at this point to impact daily tasks and general quality of life. However, this isn’t to say symptoms are not present. Family and friends may notice changes in a person’s movement, recognise poor posture, and see differences in facial expressions at this early stage.

Hallmark side effects and symptoms of stage 1 Parkinson’s disease include tremors and other movement issues that tend to be exclusive to one side of the body. Fortunately, there are prescription medications that can be effective for minimising these types of symptoms in the early stages.

2. Muscle Stiffness and Posture Problems

Stage 2 of Parkinson’s disease is considered a ‘moderate’ form of the condition, with symptoms becoming more noticeable than the previous stage. Examples include noticeable tremors, stiffness, and trembling. Also, changes to facial expressions can occur but are not always apparent to others. 

Although stage 2 doesn’t usually cause balance-related issues, other movement symptoms such as muscle stiffness can make tasks more challenging to achieve. Additionally, the condition can hinder a person’s posture at this stage, leading to back and neck pain. At this point, the disease can impact both sides of the body (although it is usually worse on one side), and difficulties with speech can also occur.

Progression from stage 1 to 2 can take anywhere from months to years, and there aren’t any reliable methods to predict the way it will progress at present. People in stage 2 of Parkinson’s can generally live alone but tend to find everyday tasks more difficult.

3. Poor Reflexes and Balance Issues

The third stage of Parkinson’s is considered mid-stage Parkinson’s progression and a significant turning point in how the disease will progress from here on out. While many of the symptoms remain the same or similar to that of stage 2, stage 3 can also introduce poorer reflexes and loss of balance at times. For this reason, people in stage three experience more noticeable movement issues or appear to ‘slow down.’ Unfortunately, at this stage, falls become more frequent due to balance and reflex problems. 

Due to the various issues this stage presents, daily tasks are much more difficult to do, but people can still live independently. A combination of medication and therapy can help to manage the symptoms mentioned above.

4. Poor Motor Skills

The critical factor in separating people with stage 3 Parkinson’s and stage 4 is independence. Motor skills and deep brain stimulation are heavily impacted at stage 4 and as such, movement symptoms affect a person’s ability to retain their independence. Some people at stage 4 can stand confidently and without assistance, and some can walk without the help of equipment or another person, but it’s not uncommon for a person to require assistive equipment such as a walker.

As we said, every Parkinson’s case is unique. Therefore, many people cannot live alone in stage 4 of the condition due to a significant impact on their movement and reaction times. Of course, there will be cases in which people opt to live alone at this stage, but the reality is that daily tasks can become extremely hard and sometimes dangerous.

5. Severe Stiffness

Stage 5 of Parkinson’s disease is the final and most debilitating stage of the disease and reflects the most advanced progression. Severe stiffness can make it difficult, if not impossible, for a person to stand or walk. This is due to stiffness causing the legs to essentially freeze when the patient attempts to stand. These symptoms make daily tasks impossible and very dangerous for someone to attempt without assistance. Therefore, it’s common for stage 5 sufferers to need a wheelchair because of an inability to stand without help — meaning they often require supervision to avoid falls.

Furthermore, up to 50% of Parkinson’s patients in stages 4 and 5 experience confusion, hallucinations, and delusions. For clarity, hallucinations are seeing things that aren’t really there, and delusions are when a person believes something despite evidence to the contrary.

Alternative scaling for Parkinson’s disease

One criticism of the Hoehn and Yahr scale is the fact that it only focuses on issues relating to movement and the subsequent problems they cause. However, other symptoms are associated with PD, such as various forms of cognitive changes and impairment, including the onset of conditions like REM sleep behaviour disorder.

For this reason, some doctors opt for an alternative, the MDS-Unified Parkinson’s Disease Rating Scale. This scale consists of fifty comprehensive questions to analyse motor and non-motor symptoms to achieve a broader view of a patient’s difficulties. Their findings can help to rate cognitive function impairments that make daily tasks more difficult, alongside the movement issues, to offer more effective forms of treatment.

While more complex, it does offer medical professionals a more thorough insight into a person’s specific impairments and needs. With more knowledge and data to hand, doctors gain a more complete picture of a person’s mental and physical state rather than simply their motor skills.

Book an appointment at our London Neurology clinic 

If you or someone you know is showing signs of Parkinson’s disease or has been diagnosed and requires additional insight, the neurologists at our leading London clinic can help. Please get in touch with our helpful team of specialists to discuss your options and the next steps.